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    <div class="d1">
        <h1>心理调查表</h1>
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    <div class="d2">
        <div class="d2_1">
        <P>1、姓名</P>
        <input type="text" placeholder="请输入">
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      <div class="d2_1">
        <P>3、性别</P>
        <input type="text" placeholder="请输入">
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      <div class="d2_1">
        <P>5、联系方式</P>
        <input type="text" placeholder="请输入">
      </div>
      <div class="d2_1">
        <P>7、生理疾病名称</P>
        <input type="text" placeholder="请输入">
      </div>
      
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    <div class="d3">
        <div class="d3_1">
        <P>2、年龄</P>
        <input type="text" placeholder="请输入">
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        <P>4、地址</P>
        <input type="text" placeholder="请输入">
      </div>
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        <P>6、身份证</P>
        <input type="text" placeholder="请输入">
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        <P>8、症状</P>
        <input type="text" placeholder="请输入">
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    <div class="d4">
    <div class="d4_1">
        <input type="checkbox" id="checkbox1" name="checkbox1">
   <label for="checkbox1">由于校园原因</label>
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   <label for="checkbox1">由于家庭原因</label>
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   <label for="checkbox1">由于社会原因</label>
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    <label for="checkbox1">由父母带大</label>
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   <label for="checkbox1">父母离异</label>
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